Manager Medical Pre Authorisation

About the Role

Bupa Arabia is seeking a Manager - Medical Pre Authorisation to lead preauthorization decisions. This full-time role is based in Jeddah and focuses on ensuring clinically appropriate and evidence-based healthcare approvals.

Role Purpose and Impact

The primary purpose of this role is to ensure clinically sound and evidence-based preauthorization decisions. This involves effective utilization management, adherence to regulatory compliance, and active provider engagement to safeguard patient outcomes, enhance customer experience, and optimize healthcare resource utilization.

Key Responsibilities

• Apply evidence-based medicine, clinical guidelines, and policy terms during preauthorization reviews.
• Ensure appropriate utilization of healthcare services while preventing unnecessary costs.
• Support cost-containment initiatives through effective medical adjudication and utilization management.
• Ensure clinically sound and consistent medical decisions.
• Monitor decision quality and adherence to medical protocols.
• Promote provider satisfaction through effective communication and partnership management.
• Manage and escalate high-value, complex, or critical cases as required.
• Participate in complaint resolution and support business continuity efforts.
• Maintain effective communication with internal and external stakeholders.
• Report operational risks and critical incidents in a timely manner.

Compliance and Governance

• Ensure adherence to Bupa policies, medical protocols, and regulatory requirements.
• Comply with CHI regulations and governance standards.
• Identify, escalate, and report suspected fraud, waste, abuse, and anti-selection activities.
• Support audit readiness and compliance monitoring activities.

Experience Requirements

Candidates for this position are required to have 3-5 years of relevant experience in medical pre-authorization or a related healthcare management field.

Work Location

This full-time position is based in Jeddah. Qualified candidates are encouraged to apply.